(1/5)
TdT is the “WILD CARD” dealer of the immune system 🃏🧬
It shows up in blasts because it’s active only when lymphoid cells are still being built.

🧠 TdT’s real job:
It adds random DNA letters (N-nucleotides) during V(D)J rearrangement → making every B/T-cell receptor unique.

✅ Receptor complete → TdT turns OFF
So this becomes a powerful maturity marker:

💡 TdT+ = “Work in progress” (immature / blast)
💡 TdT- = “Finished product” (mature cell)

#HemOnc #PathTwitter #MedEd #Oncology #OncoTwitter

@ASCO @myESMO @OncoAlert @ESMO_Open (2/5)
So whenever a malignancy is stuck in the construction phase 🏗️, TdT lights up.

🔥 Classic TdT-positive diseases (the “WHO”)

1️⃣ B-ALL / T-ALL and Lymphoblastic lymphoma (LBL) → usually strong TdT+ (>95%)

2️⃣ BPDCN (Blastic plasmacytoid dendritic cell neoplasm) → rare but aggressive mimic

3️⃣ Acute undifferentiated leukemia → often TdT+

4️⃣ AML (the trap ⚠️) → ~20% can show TdT aberrantly (lineage infidelity)

📌 Take-home: TdT is a “blast marker” more than a “lymphoid-only marker.”

#HemOnc #PathTwitter #MedEd #Oncology #OncoTwitter

@ASCO @myESMO @OncoAlert @ESMO_Open

Every January, oncologists promise the same thing.
“I’ll read trials more carefully this year.”

Then we read the abstract conclusion and move on.

Here’s the uncomfortable truth:
📣 Abstracts sell drugs.
📊 Data tells the truth.

Let me show you how to autopsy a Phase III oncology trial quickly 🧵👇

#Oncology #MedEd #MedTwitter
@OncoAlert @myESMO @ESMO_Open @ASCO 🔪 Kill Shot #1 – The Control Arm Test

Before admiring the new drug, interrogate the comparator.

Ask yourself:
🧠 Would you treat your patient this way today?
🧠 Was the dose optimal or conveniently low?
🧠 Was crossover allowed or blocked?

A weak control arm can manufacture a beautiful hazard ratio.

#Oncology #MedEd #MedTwitter
@OncoAlert @myESMO @ESMO_Open @ASCO

(1/7)🧵 If cancer were a lottery, whales should lose every time.

If cancer were a biological lottery, blue whales should lose every time 🐋

They have 1,000× more cells than humans.
More cells = more mutations = more cancer.

By probability, whales should never reach adulthood.
Yet they live 90+ years.

This is Peto’s Paradox 👇

@OncoAlert @myesmo @esmo_open
#OncoTwitter #MedTwitter #CancerBiology #ScienceTwitter #Evolution (2/7) The Paradox
Cancer starts when one cell mutates and keeps dividing.

So logic says
📈 more cells
📈 more divisions
📈 more cancer

By that logic, a whale should be a walking tumor.
Reality says otherwise.

@OncoAlert @asco @esmo_open
#CancerResearch #Biology #ScienceExplained #MedEd #Oncology

1/5
We know BRCA1 and BRCA2 mutations both sensitize tumors to PARP inhibitors via synthetic lethality. But clinically, not all responses are equal. 🧐

Data frequently shows that BRCA2 responses are deeper and more durable than BRCA1.
Why the difference?

It comes down to their specific jobs in the DNA repair assembly line.

A short thread 🧵👇
#MedTwitter #Oncology #PrecisionMedicine #BRCA
@OncoAlert 2/5
Think of Homologous Recombination (HR) repair like a construction site repairing a broken bridge. 🌉

🏗️ BRCA1 is the Site Manager: It does crucial upstream signaling, organizing the site, and preparing the broken ends.
If the manager is sick, it’s chaotic, but workers might still patch things up inefficiently.

🏗️ BRCA2 is the Crane Operator: Its main job is to directly load the actual repair materials (RAD51 proteins) onto the break.

#MedTwitter #Oncology #PrecisionMedicine #BRCA
@OncoAlert

(1/5) HER2 testing is NOT "one size fits all." 🧬
If you apply Breast Cancer scoring rules to Gastric Cancer, you are creating a recipe for false negatives.

Biology dictates the guidelines.

Here are the 3 Critical Differences between HER2 in Breast vs. Gastric/GEJ. 🧵👇
#Oncology #MedEd #Pathology
@OncoAlert (2/5)
1️⃣ The Staining Pattern: "Ring" vs. "U"

• Breast: We look for the classic "Chicken Wire."
• Rule: Complete, circumferential membrane staining is required for 3+.

• Gastric: Incomplete staining is normal.
• Rule: Look for basolateral or lateral staining (a "U" shape).

💡 Pearl: If you wait for a complete ring in Gastric cancer to call it positive, you will miss eligible patients!

#Oncology #MedEd #Pathology
@OncoAlert